New Psychoactive Substances *NOT FOR HUMAN CONSUMPTION*

‘Legal Highs’ ‘Novel Psychoactive Compounds’ ‘Research Chemicals’ ‘Bath Salts’ ‘Herbal Incense’ ‘New Unregulated Drugs’ ‘Designer Drugs’ ‘Plant Food’

Paula Hinks & Georgia Ramsay-Smith So what are they???

• This presentation refers to New Psychoactive Substances (NPS) which is an umbrella term which includes ‘legal highs’ (sold in Head Shops) & club drugs.

• Legal Highs produce similar effects to illegal drugs such as Cocaine, Ecstasy and Cannabis. They are not controlled under the Misuse of Drugs Act. They are however, considered illegal under current medicines legislation to sell, supply or advertise for “human consumption”.

• To get around this sellers refer to them as research chemicals, plant food, bath salts, herbal incense or potpourri, and label them as ‘not for human consumption’.

Where do they come from??

• Head shops – There are currently 6 known head shops in Brighton including Red Eye (Gardiner Street), Hempworks (London Road), One Love (Lewes Road) • Online retailers – Skunkworks, Legal High Store, The Herbal High Company etc • Mostly synthesised in labs in China and India and then exported, legally, to the UK. • New substances emerge at a rate of 1 PER WEEK! • Approximately 1 in 10 ‘Legal Highs’ contain an illegal substance* . Stimulants (Legal and illegal) • Examples: Poke, Rush, Mephedrone, Magic Crystals, Crystal Meth, MDMA, Cocaine, Ecstasy, China White, Gogaine, Euphoria, Amphetamines, Khat.

Mephedrone So what do they do?

• Positive effects: feelings of euphoria and empathy, increased sexual arousal and prolonged sexual activity, suppressed appetite, increased energy, heightened sociability.

• Negative effects: anxiety, panic attacks, Serotonin Syndrome, insomnia, increased heart rate, strong desire to re-dose, muscle spasms, potential to inject, deterioration in mental health, loss of appetite, weight loss, nose bleeds common with snorting powders.

• Treatment response: recently a client was admitted to Millview for an inpatient detox from Mephedrone.

Hallucinogens

• Examples: AMT, 2CB, 2CI, LSD, Magic Mushrooms, Salvia, PCP, Ketamine and MXE What do they do?

• Positive effects: increase feelings of empathy, more energy, personal insight, creative dreamlike experience, increase in aesthetic appreciation.

• Negative effects: Severe dissociation, paranoid thoughts, unpleasant hallucinations, cardiovascular symptoms, can cause nausea and vomiting, confusion, muscle ache, psychosis, effects can take up to 2 hours to kick in so risk of double dosing, risk of serotonin toxicity, active dose is very low, fear/panic, loss of body control, varying degrees of potency.

• Treatment: senior clinicians are looking into the viability of offering an inpatient Ketamine detox. A fast track referral system has been put in place with the Urology Department for Ketamine users .

Depressants

• Examples: GBH/GBL, Alcohol, Benzodiazepines (Diclazepam & Etizolam, not licensed), DXM, AH-7921 (Legal Heroin), Nitrous Oxide, Amyl Nitrate What do they do? • Positive effects: Physical relaxation, loss of inhibitions, enhanced sex drive, can ease stimulant comedowns (parachuting), increase dopamine levels

• Negative effects: depress the central nervous system, slow down breathing & heart rate, can cause drowsiness. You can become physically and psychologically dependent with extended use, easy to overdose, especially when combined with other depressants.

• Treatment response: due to the complexity of the detox regime, dependant GBL/GHB users need to be detoxed within Millview Hospital. GBL has been found to decrease the effectiveness of some HIV medication. Synthetic Cannabinoid Receptor Agonist (SCRA)

• Examples: Pandora’s Box, Clockwork Orange, Train Wreck, Spice, Cherry Bomb, Exodus Damnation, Black Mamba, Annihilation What do they do? • Not synthetic Cannabis: it is a chemical compound which has been sprayed onto dried plant matter & is much more potent than Cannabis.

• Positive effects: euphoria, relaxation, increased confidence, enhanced senses.

• Negative effects: nausea, vomiting, hallucinations, irregular heart beat, paranoia, memory loss, depression, suicidal ideation, agitation, anxiety, extreme sweating, upset stomach & diarrhea, kidney damage, can contain 3-13 different compounds.

• Treatment response: client has recently completed a detox for the use of SCRA in residential rehabilitation. The majority of referrals are coming from mental health services. Clients have reported physical dependency much stronger than Cannabis.

Confused

• Don’t be – although many of the NPS have strange names that are constantly changing, just remember that these substances fall into one of the categories we have just discussed, and the substances have been designed to mimic the most common illegal substances that we know so well.

• The intervention is exactly the same as it would be for something that is illegal. The client is the expert, don’t feel embarrassed asking them questions about what the substance is and does.

• Focus on the effects and the problems that have arisen.

Case study – Carla

Trading Standards (Fair Trading Officer): Donna Lynsdale

Wednesday Night Drop in 5-8pm [email protected] 07738801694

NPS & Club Drug Support Group 6:30 – 7:30 (referral required)

LGBT specific post who also supports NPS users, links with THT, Claude Nicol, Lawson Unit NPS & Club Drug Outreach Worker

[email protected] 07554112203 / 01273 607575

Offers an outreach service within the community to engage clients into Tier 2 (brief intervention) or Tier 3 (structured treatment) Prevelance of NPS in A&E Admissions

100 90 80 70 60 Admissions 50

40 30 20 10 0 Stimulant Depressant Hallucinogen Cannabinoid NPS category How to refer

Direct people to the Wednesday night Drop In 5-8pm @ No.11

Referral forms for Tier 2 Brief Interventions can be emailed to [email protected]

Or drop in to Open Access Monday – Friday from 10am for an assessment.

Or, ring the NPS helpline for advice/information on 07793619993 Key Harm Reduction:

1. Research - do your research first. Read a variety of user reports online (Erowid)

2. Start low, go slow - Don’t gauge quantities by eye, use correctly calibrated scales. Base initial dose at the low end of the active dose range, allowing for your body weight where possible. Wait 3-4 hours before re-dosing.

3. Avoid poly drug use - don’t mix with other drugs (or alcohol) or prescribed medicine.

4. Don’t use unknown chemicals - unless you are in good physical and mental health.

5. Have a sitter - who knows what you are taking, will not use anything themselves, and will call an ambulance without any hesitation.

6. Don’t over do it - Give yourself a good chance to recover before re-dosing. If you like the experience only increase quantities very slowly and carefully.

7. Know the related drugs - Assume at the least that these compounds will have similar risks to related compounds in the same family.

8. Supply & storage – don’t bulk buy and ensure safe storage (in a locked cabinet).

9. Practice safe sex – many of these substances increase sexual arousal so ensure you always have condoms ready. Resources

• The client • EROWID http://www.erowid.org/ • Think Drink Drugs http://www.thinkdrinkdrugs.co.uk/ • Frank http://www.talktofrank.com/ • CRI http://www.cri.org.uk/ • KFX http://www.kfx.org.uk/ • NPS Development Lead: Michael Lawrence ([email protected]) 07880357282 • Twitter: @ClubDrugs_CRI • Advisory Council for the Misuse of Drugs (ACMD) https://www.gov.uk/government/organisations/advisory- council-on-the-misuse-of-drugs • WEDINOS (Welsh Emerging Drugs & Identification of Novel Substances) http://wedinos.org/index.html

Any questions???